[Congressional Record Volume 145, Number 114 (Thursday, August 5, 1999)]
[Extensions of Remarks]
[Page E1748]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  INTRODUCTION OF THE MEDICARE PARAMEDIC INTERCEPT SERVICE EQUITY ACT

                                 ______
                                 

                           HON. SUE W. KELLY

                              of new york

                    in the house of representatives

                       Wednesday, August 4, 1999

  Mrs. KELLY. Mr. Speaker, I rise today to introduce the Medicare 
Paramedic Intercept Service Equity Act, legislation which will provide 
reimbursement for critically needed ambulance intercepts, no matter 
where they occur.
  In the past, paramedic ambulance companies have billed Medicare for 
services administered to beneficiaries during an intercept. In May 
1995, the Health Care Financing Administration discontinued allowing 
the paramedic ambulances to bill Medicare, stating that they only grant 
payment for services provided by the transporting ambulance, which 
under an intercept would be the non-billing volunteer ambulance. This 
policy precludes paramedic ambulances from receiving Medicare payment 
for their services.
  According to the providers this policy has proven to be a nightmare. 
It creates a situation in which the volunteer personnel might choose to 
not call paramedic personnel, even if it is against their best 
judgment, because the patient may not be able to afford the cost of the 
paramedic care. The billing of the patient could also be avoided, if 
the patient is physically transferred from the volunteer ambulance to 
the paramedic ambulance, thereby making it the transporting ambulance 
but, in the process, wasting time that could be critical to the well 
being and survival of the patient. However, if the volunteer company 
does choose to call paramedic personnel, then the cost is passed on to 
the patient.
  Although carriers have begun billing patients for their services, 
they often waive the charges for seniors who cannot afford to pay the 
bill. As a result of this policy, many paramedic ambulance companies 
are experiencing serious financial losses and may have to go out of 
business, which jeopardizes emergency care. Additionally, many seniors 
have taken to calling paramedic providers to describe their conditions 
to see if they would require their services, before calling the 
volunteer ambulance.
  In 1997, Congress addressed this issue in the Medicare provision of 
the Balanced Budget Act. This provision amended the Social Security Act 
to provide coverage in rural areas for paramedic intercept services 
under Medicare Part B. This change was intended to allow paramedic 
ambulance companies to bill Medicare for their services despite the 
fact that they were not the transporting vehicle. Yet under the Health 
Care Financing Administration's proposed methodology, many areas which 
would commonly be thought of as rural are not considered as such under 
the rule. Thus, these areas have all the problems of being rural, yet 
have none of the protections that Medicare reimbursements for paramedic 
intercept services would provide.
  As a result, one town with the fortune of being classified as rural 
has paramedic intercept coverage, while the town directly next door 
with the same basic rural nature, but a few more residents has no 
coverage. This leaves seniors stuck in the middle, confused as to what 
areas are covered, and scared to call for an ambulance for fear they 
will be charged with a bill they cannot afford. The policy of only 
reimbursing ambulance intercepts that occur in rural areas 
geographically discriminates against Medicare beneficiaries by 
arbitrarily setting standards for reimbursement that will help only 
those seniors with the luck of living in a federally defined rural 
town.
  Paramedic intercepts should be covered by Medicare no matter where a 
senior lives. If a senior is in medical need of an intercept, then 
Medicare should pay for it. The Medicare Paramedic Intercept Service 
Equity Act takes the debate over coverage out of rural vs. urban and 
towards one of medical necessity. Specifically, this bill strikes the 
word ``rural'' from the ambulance intercept provision of the Balanced 
Budget Act. In doing this, all intercepts are covered whether they are 
in a rural area or not.
  Please join me in providing seniors with the critical emergency 
services they need and cosponsor this important bill.

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